Matt- Wild Rose Tattoo

Wild Rose Tattoo

TATTOO CONSENT FORM
Client Information

For a service with Matt James, License #BAP-TA-666255
This is an intake form before a service, *not* a booking inquiry form.
Please check here to say you understand that this is a health screening form for the day of a scheduled tattoo, NOT a booking inquiry. Booking information is on our website!*

I understand .
Full Name*

First NameLast Name
Pronouns
Age*
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Email*
example@example.com
Would you like to receive emails from Wild Rose about news and events?

YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pre-tattoo Questionnaire
Are you under the influence of drugs or alcohol? (If you mark yes to either of these, we cannot tattoo you.)*

YesNo
Are you pregnant or nursing? (If you mark yes to either of these, we cannot tattoo you.)*

YesNo
Do you have any symptoms of cold or illness such as cough, fever, congestion, shortness of breath, gastric upsets, etc? If yes, by filling this form I agree to also VERBALLY tell my artist about such conditions.*
If yes, please identify the condition.
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.) If yes, by filling this form I agree to also VERBALLY tell my artist about such conditions.*
If yes, please identify the condition.
Medications that may effect the tattoo or healing (e.g. Blood thinners, acne medications, antibiotics, anti-rejection drugs, etc.) If yes, by filling this form I agree to also VERBALLY tell my artist and have cleared it with my doctor that I am safe and able to be tattooed.*
If yes, please identify the condition.
Medical History (e.g. Auto Immune Disorders, DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.) If yes, by filling this form I agree to also VERBALLY tell my artist about such conditions and have cleared it with my doctor that I am safe and able to be tattooed..*
If no, type "no". If yes, please identify the condition.
Acknowledgment and Waiver
*

I agree to not bring any guests without prior approval from my artist.
*

I understand that this procedure is a permanent change to my skin and body.
*

I agree to have eaten a protein rich meal no longer than two hours before my appt.
*

I allow my tattoo to be photographed and shared on Matt’s and Wild Rose Tattoo's social media accounts.
*

I acknowledge that Wild Rose Tattoo does not offer refunds.
*

I agree that the studio does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo.
*

I understand that I need to take care of the tattoo by following the instructions given to me by my artist.
*

I understand that I might get an infection if I don't follow the instructions given to me in regards of taking care of my tattoo.
*

I indemnify and hold harmless Wild Rose Tattoo and the artists therein against any claims, expenses, damages, and liabilities.
*

I understand that it is my responsibility to make sure any script in my tattoo is spelled correctly.
Front of current, government issued ID. (Driver's License/passport)*

Browse Files

Cancelof
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I confirm that the information I provided in this document is accurate and true.
Signed Date*

MonthDayYear
Date
Client Signature*
Should be Empty:

Wild Rose Tattoo

Client Information

This is an intake form before a service, *not* a booking inquiry form.

Pre-tattoo Questionnaire

Acknowledgment and Waiver

This is an intake form before a service, not a booking inquiry form.